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Home My WebLink About18783-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20227 Date SEPT~EMBER 18r 1991 THIS CERTIFIES that the building. Location of Property 195 OAK STREET House No. County Tax Map No. 1000 Section 141 Bubdiuision ADDITIONS MATTITUCK~ N.Y. Street Block 1 Lot 23 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 29~ 1990 pursuant to which Building Permit No. 18783-Z dated FEBRUARY 8¢ 1990 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION ~ ROOFED OVER DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTYDEPARTMENTOFHEALTHAPPROVAL N/A UNDERWRITERS CERTIFICATE NO. B-024256 - SEPTEMBER 10g PLUMBERS CERTIFICATION DATED N/A 1991 Rev. 1/81 ~ Bui~lding Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo No_ BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18783 Z ~te ......................................... , ~.. pursuant to application dated ........ ././..~.~.. ................................ , 19....~..'.~., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~N HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/I0 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. ~or existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $I0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ............. New Construction .... ~..... Old Or Pre-e~istin~ Buildin~...~..~..., ...... ocation of Prop =y ..... .... ..... ................. House No. Street Hamlet Onwer or Owners of Property.../DE.~..01~.~....~.~J...~.[.~.. .............................. County Tax Map No i000, Section ............. Block ................ Lot ...... Subdivision ......................... Filed Map ............ Lot ............ Permit No...~..~..~.~.~. ..... Date Of Permit. ~ l' ~' l' .~.0...Applicant... ~.C.~..~/..~..~.~. ~..~..~.. Health Dept. Approval ....................... ... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ..... TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL SOUTI{OLD. N.Y. 11971 HR. BRADLEY JENSEN 19.50/~ STREET HATTITUCK, N.Y. 11952 AUGUST 7, 1991 TEL,. 765-] 802 To Whom This May Ce,Scorn, We are unable to complete your Certificate of Occupancy because .of the following reasons. /_~ {\n application for Certificate of Occupancy --~ls not on file. ' (ENCLOSED) ~ ~ /~/t~o Underwriters Certificate on file..-~ /_~ ~he' - ' check is(~x,~a~-~-~x3~Jnot on file.) $25.00 ~. /--/ No Health Dept. Approval on file. /_--/ No final inspection has been made. Please co~tact our office on this matter. Thank you for your cooperation. Dui]ding Permit ti I 8' 7, 8 3 Z. Building Dept. ***/--/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,19~4 ) FOUNDATIO.U ( ls t) FOU:;DATI O'J 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION ~]~RAMING [ ] FINAL DATE INSPECTOR ~/ 765-1802 BUILDING DEPT. .INSPECTION FOUNDATIION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [~/~NSULATION FRAMING FINAL REMARKS: ~ 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INS~JJI~TION FRAMING ~ FINAL DATE INSPECTOR/~~/~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST I ] ROUGH PLBG. FOUNDATION ZND [ ] INSUI.ATION I' ] FRAMING [ I~'I~NAL DATE INSPECTOR llldl am Z 91~0' 1/11 TOWN OF SOUTHOLO ~ T .... ~ TEL.: 765-1802 Disapproved ale ..................................... / (B~ing Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH . . SURVEY ............ Sg?~IC ~O~H ............... NOTIFY; MAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witl sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ otVmo a detailed description of layout of property must be drawn on the diagram which is part of tkis ap; cation. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pen~ shall be kept on the premises available for inspection throughout the work. 6. No building shall be occupied or used in whole or in part for a,ny purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appIicable Laws, Ordinances Regulations, for the construction of buildings, ad~ditions or alterations, or for {emoval or demolition, as herein describe The applicant agrees to comply with all appHcabie laws, ordinances, building code, housing code, and regulations, and admit authorized inspectom on premises and in building for necessary i~ /~_ _.._~ _ .... .;,?-' '~'.f_'_'_~,~_ %:/~;',' ..... t; ........ '.. - t.~lgnature ot appll6a'n[, or name, il a corporallon) .../f47... A... (Mailing address of applicant) State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises.../$. A Z-' ¢.. ............................................... (as on tlie tax roll or latest deed) Il" applicant is a corporation, signature o£ duly authorized officer. ' (Name ~nd titie o~' corpc;rate ~fficer) Builder's License No ..... (?..~,'. ,'~. ,~,(-. ........... Plumber's License No... f2.~..'(.Q.~. ~ .......... Electrician's License No...~22 ..~. tO..~ ~ ........ ' Othcr.Trade's License No...~)...v:ff...~{. ~../~.. ~ ..... I. Location of land on which proposed work will be done: //, A, A, /.? ~" o.~..~ .s./. ' House Number Street, Hamlet County Tax Map No. I000 S~ction .... Subdivisien ..................................... Eiled Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing Use and occupancy ...... .~-~ .~ ~ -~¥ ...... ~._¥ ....................... b. Intended use and occupancy · ............. ~~'2~ .............. 3. Nature of work (check which applicable): New Building .......... Addition .... .~- .... Alteration ......... Repair ........ ~ ..... R~moval .............. Demolition ........... Sw'imai~, pool .......... Tennis Court ......... Accessory Building ......... '.'Fe~e ...., .:..O~o)k~O... ...... ................................ Fee .......... ; .~.~.~n~.~ ...............~4 ~... (to be pa!~ on ffli~g3hiS.~.pli%~ion 5. If dwelling, numberofdwellingunits...........,... Nnmber of dwelling units on each floor . . .......... . . . If garage, number of cars ................................................................. . -.... 6. If business, commercial or mixed occupancy, specify.nature and extent of each type of use ................... ..... 3a ' 7. D~mensmns of extst~ng structures, ff any: Front ............... Rear ........... Depth ......... Height ...............Number of Stories .. ,%-. ............... ............................. . . .. .. Dtmensmn.%of,same structure with alterations or additions: Front ................ Rear . ~ O. ........... Depth,..~..O. ................ Height ..................... '. Number, of Stories...:~-. ............... 8. Dimens ons of entire new constrnction- Front ~ o/. Rear ,,~O . Depth .O'.q ' ~ Height .............. ~umber of Stories...2~., . 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~..O. ........................ 13. Will lot be regraded ... g~. g .......... Will excess fiI1 beremoved from premises: Yes ,~.. No 14. Name of Owner ofpremises/~rqdJ.{~ :~.e'.~Xel .,3::. Address /.,0.4~. ~..~.R...5/~ ..... Phone No..;~-9.. ~.x~...ff.~'..~-. Name of Architect ..... S. ¢..r?2 .~ .... Address,0/JJ.,: .t-tr~../~/.~... Phone No .............. _ Name of Contractor .... .5.qro..q...~ _.' ............... . Phone No .......... ~i. 15 Is this property located Within'l'O0'Address · feet of a tidal''w~"tland? *¥ES...~NO.P'.- *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ~11 buildings, whether existing or proposed, and. indicate MI set-back dimensions fror, property 5nes. GDe street ~nd block number or des, interior or corner lot. STATE OF NEW Y .O tLK. COUNTY OF... ~¢9'.~.\i ¢ ~{- ..... S.S ription according to deed. and snow street names and iv dicatewhethe ......... ~.~. L,~.,.O.\.%./ ....-.~ .~. t-). ~,~..-> .............. being duly sworn, deposes and says that he is the applicar (Name of individual signing contract) above named. lie is the .......... .C; t.O..~..~ u: ........................ : ....................... ; .................. :. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th application: that all statcments contained in this application are true to the best of his knowledge and belief; and that th Work will be perforated in the manner set forth in the application qled therewith. · Sworn to before me this " 'Z qq4:~ . .day of ................. ~ 19.. Notary Publi~ ....... ,'~..?, k-%~..~;if. . ~it . . . ............ County